Interview: Jennifer Margulis, Author of The Business of Baby

Every so often an author emails me with a book they’ve written that I find simply irresistible. Some of them I enjoy reading and I’ll write up a review on Amazon or some similar site, a very few of them grab my attention so wholly that I share them here with you.

If my brain had a soundtrack you’d have heard a record player screeching. “What medical risk?” I had a zillion ultrasounds because my kids were born 20 and 24 days after their due dates (which I maintain are still very random dates). So Jennifer and I engaged in the best kind of conversation, the kind where we sort of fall in love with each other’s brains and you think it’s horrible that she doesn’t live in Los Angeles but let’s face it. The Pacific Northwest is not somewhere I’ll be finding myself any time soon.

So I did what I do best. I read the book quickly and voraciously and as I’m prone to doing with Vinnie & Anna I sent poor Jennifer random text messages as I was reading her work. She dutifully responded and I’m pretty sure every time she had to text me she was thinking: this is a lot of work to sell a book.

It’s fascinating and upsetting much in the way Food Inc was riveting and traumatic. There is much I agreed with and some that I’ll research further on my own but it’s a topic worth researching. I hope you’ll give it a read. Here’s a brief interview with the author.

JG: I’ve already had my babies, why do I need this book?

Jennifer Margulis: You don’t. But you kept texting me to tell me you couldn’t put it down. [I did do that]

I mean, it’s more than just a wake up call to people having kids now, the book is investigative journalism exposing the widespread conflicts of interest in the medical world that twists our parenting away from the methods that get the best results and towards the ones that get the best profits. I think everyone can benefit from understanding what’s broken about our system. I would even venture to say that people who aren’t parents and have no intention of becoming parents, and those of us who don’t have vaginas should read this book…

JG: Okay… but also it makes me really uncomfortable to think that I didn’t give my kids the best possible start to life. Why should I be made to feel that way?

JM: Mine didn’t either. It makes me uncomfortable and sad that my baby was born doped up on drugs, taken away from me immediately, and scrubbed with soap that contains formaldehyde. I had no idea until I started this investigation, that the baby soap we use in hospitals today has so many toxic ingredients, including formaldehyde, which is also used to embalm dead people. I wish I were making that up. But just because we wish it were otherwise doesn’t mean we should keep my head in the sand and pretend it was all for the best.

But, Jessica, you didn’t do anything wrong. It’s not parents who are the problem, it’s the system. The book is designed to empower parents. It might still make you uncomfortable — I can’t tell you how many nights I lay awake furious or disturbed or sad because of what I had learned the day before — but it reveals what we all need to know to make the system better, safer, and more evidence-based.

JG:I am never ever going to have kids without an epidural. In fact I’d like to channel Betty Draper and drink and smoke through my pregnancy. I’m scared of being pregnant, will this book make it worse?

JM: I don’t have an epidural when I’m having sex because I want to feel it. If I didn’t like sex, I’d probably want an epidural. There’s a difference between pain and suffering. Laboring without an epidural so you feel what’s happening in your body can be painful, but it’s good helpful pain that you feel for a reason. You respond to it — by moving your hips, trying to climb the wall, swearing at your partner. And the movement and shifting helps your baby descend the birth canal. At the point that you are sure you can’t take one more second of it, you’re usually almost finished. A few minutes later your contractions will change and you’ll be pushing your baby out, which is one of the most powerful and primal feelings in the world. It’s addictive. I dare you to try it! You’ll end up having a bunch more kids. Of course if a woman is suffering or exhausted, an epidural is a good option. It’s a wonderful tool when it’s needed. But birth is not meant to be suffering. Best kept secret: unmedicated labor actually gets you feeling higher than drugs. Your body is coursing with oxytocin, endorphins, and adrenaline at the end to help give you the surge of energy you need to push the baby out.

I had an epidural with my daughter and the nurses refused to lower the medication when I asked them to, my leg was numb for weeks afterwards, and I got a third degree tear and painful bleeding hemorrhoids. Then I had a baby without an epidural and the whole experience was actually less painful (partly because my water broke during my first labor so right from the beginning the contractions were excruciating.) I don’t like pain and I’m not particularly tough. But when I learned that you could have fun in labor by having good support, keeping a sense of humor, and paying attention to what is going on in your body, I realized that giving birth can actually be enjoyable.

JG: In my area we just don’t talk back to doctors. Is this even realistic?

JM: A recent study showed that some two thirds of parents don’t always follow the advice they get from doctors. Instead of talking to our medical providers, we nod and smile, and then do things the way we know is best for our kids. We deal with the doctor the way we deal with our mother-in-law! But wouldn’t it be better to have an honest dialogue? Before we moved to the West Coast, we had a fantastic doctor who would come into the room and ask, “So, what’s wrong with the baby?” I answered: “That’s what I came here to ask you.” He said, “You tell me.” So I told him, “I think she has a staph infection around her mouth.” He nodded and said, “Yep, you’re right. So what are we going to do about it?” By this point I was a bit exasperated. “That’s what I came here to ask you!” I protested. “No, you tell me,” he said. And I told him what I thought — that maybe she needed antibiotics but that I wasn’t sure. Together we made a plan. I got a prescription but waited one more day. The rash cleared up by itself. That’s medical care at its finest, I think. This doc spends as much time with each patient as needed. And you’ve probably figured out by now that he’s losing money for his practice.

JG: I want to give this book to my daughter/daughter-in-law/neighbor/friend. How do I do that without them thinking I’m barging in on their life?

JM: Good question. When you find an awesome skin cream or eat at a great new restaurant and recommend it to your friends and family, you’re not barging in on their lives, you’re just sharing a discovery. I guess if you approach it like that … by saying, “This is a book I wish I had when I was pregnant,” and telling them what you learned from it. That way you’re sharing information and a new discovery, not trying to tell them what to do. That make sense?

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I can second Jennifer’s experience of an epidural-assisted labor and then labor with an epidural. My 1st, epidural-assisted labor (and subsequent recovery) was far more uncomfortable than my 2nd labor (no epidural, 1 half-dose of IV Nubain, jacuzzi) — so much so, in fact, that my immediate thought after pushing the baby out was, “I want to do that again!” Labors #3 and #4 were completely unmedicated.

Jessica, sounds like an interesting book with many substantial comments about labor and delivery.As a nurse, who worked in L & D, I always read this type of writing with a lot of skepticism.Certainly, there could be improvements the way doctors treat pregnant women and laboring moms. But I have to say if we are to be realistic this is not going to change anytime soon.Doctors in OB-GYN are products of their residency programs and it takes them a very long time to develop their own style of practice…some will be caring and empathic as well as great physicians, others will be great practitioners but not so good with the empathy etc. and then there are those that are not good but empathic…the worst choice is to choose a doctor who is empathic but not a good clinician.Without a medical background making this choice is in my opinion very difficult…and many times you find out what your doctor is made of when you are in labor which can be problematic if your views of what you need differ with his.My advice has always been to encourage a woman to make her choice carefully and find someone with good credentials that seems to be caring and a good listener…not easy. Along with this, a woman should take a look at the hospital or the facility where she is planning to deliver because a doctor can be all that you want but his hospital may not be.Also some more advice…pick your battles.The baby wash maybe something very important to you but I think most hospitals use a wash that aids in protecting the newborn from infection that could be transmitted from the birthing process and from hospital contamination. So find out the reasons for the what and why of these Policies and Procedures.As far as the use of epidurals and pain relief…I could write my own book just based on my professional and personal experience. Suffice to say that everyone experiences pain differently and is entitled to pain relief if they want and need it.Do not make the mistake of interpreting your personal L & D experience and then making generalizations to other moms.As a nurse, it should be totally offensive to a laboring mom for me to do this as she is having her own “unique” experience.And last but by far not least…the new arena of healthcare which is undergoing a severe reality check based on the problems and difficulties that comes with implementation of new constraints from the Federal government will make a book like this fairly obsolete in a short period of time. As patients, it is my belief that the overhaul of healthcare will discourage many good physicians from choosing OB as their specialty simply because their practice will be out of their control in so many ways.It will cost them an enormous amount of money to become a doctor and then why would they choose to be in one of the most litigious specialties.I hope I did not offend anyone with my response, I believe in investigative reporting but I just see this type of material difficult to write about from a non-medical background…and I also never like to see one woman’s labor compared to another unless it is evidence based, generalizations are not what is needed.I realize I have not read this book so my comments are really based on the Q & A here…it is not a book review. Thanks for sharing, I always enjoy reading about the business of medicine and how it is perceived by the consumer…it makes us better practitioners.

Great interview. I’ve got the book on pre-order and can’t wait to read it. The system is so, so broken. We tried to do things as non-interventionally as possible, but even that was a struggle back in the 1990s when we had our babies.

Thank you for this book. I’m eager and nervous to read it, having had something like 15 ultrasounds (not entertainment, but even being high risk, I probably didn’t need all of them) during my pregnancy. I kept thinking, there must be some risk, but everyone assured me there was none. From your interview, sounds like there are?? Even feeling like I did so much to have a healthy pregnancy and labor, it feels like it’s never enough. But it is important to have this information.